Cool little things...

One of the cool things about my course right now is that I'm backwards diagnosing some of my old patients...

Boy with big floppy ankle? Oh - he had a Potts fracture! Lovely old lady with Angina? Unresponsive to her sublingual spray and duration of pain makes that a possible AMI (and makes me very happy I called the ambulance!). Carpal spasm? Hypoventilation due to drug use!

You get the point...

Looking back on most of the patients I don't think I'd have done anything differently back then... which is a good thing I think... Doing it now, I'd do a lot more - but only because now I have that extra training, knowledge and resources I'd be more confident in my treatments. There were times when I wished I could administer advanced pain relief, confidently read an ECG or even just move the patient in some circumstances - none of which I was legally allowed to do with St John.

I guess my point today is this; from here on in I'll get to do all of the cool little things that make big differences in patient comfort and outcome...


Until of course I go up the next training scale and look back again!

Bigger than a band-aid

One thing I remember happening in St John a few times was that you would get 'senior' members who flat out refused to do anything but the 'big' cases. I'm not sure if I've blogged on this before, so if I have - bugger - if not, great. Because it's something that keeps popping up in my Paramedics training at the moment...

The thing that got me with the people in St John (and I don't doubt you'd find these in every emergency medical/first aid service) who were of the 'big stuff only' mindset was that they were missing the two biggest points to do with pre-hospital care; looking after people's health and looking after people. I was extremely pleased to see that one of the steps in Protocol 1 (the very first Protocol!) in our protocol book is 'REASSURANCE'.

The people who only seek the 'big' cases (BC's for short from here on!) miss out on the real work of any good ambo - looking after people, regardless of if anything is actually wrong or not. The big test is usually if someone comes into a first aid post looking for a band-aid. Our BC's scoff at the thought of applying a mere band-aid, such is their skill and prowess that they must hold themselves in reserve in anticipation of that big fish. In my opinion, it is the humble, friendly member who puts the band-aid on the persons (usually smelly) feet, has a chat with them and walks them out the door when they're ready that is really doing the good work. Because they're fulfilling both neccessary steps of being a good medic.

Unfortunately I've seen a BC in action at an OD, the patient was transfered to an ambulance at said BC walked off grinning at what a good job they'd done. Right past the girlfriend crying because she didn't know if she was going to see her boyfriend alive again (which in that case she definitely would, although perhaps a second trip to hospital would follow his initial release thanks to said girlfriend's 'welcome home'). I remember the look on her face - desperate and vulnerable, terrified and lost. Fortunately a nurse got to her and directed her to another vehicle headed to the hospital, they had a chat before she went off and I don't doubt for a second it did her the world of good. The patients on our run sheets and cas forms aren't the only people we treat. A smile, a slight touch of reassurance, a kind word are often worth more than the most expensive equipment you can pack into an ambulance.

I know that, as often happens, I will grow tired of doing the little things. I won't want to put the band-aid on the foot, I won't want to do the simple little procedures. I like to think I'd do it anyway with a smile, or hand it to a probie (be nice to probies! please?) who needs these experiences - but not because I feel I'm above it.

They drill into us here that we are public servants in all senses - we will politely oblige the lovely old lady who has fallen over in her thirty roomed mansion. We will also politely oblige the homeless man who has passed out in a pool of filth.

I hope that no matter how much training or experience I get, I will never - for an instant - think I am bigger than a band-aid.

Heavy lifting

This is a retrospective message out to the ~150kg man who briefly passed out on the basement level of an event. Myself and a guard had to carry him up a narrow flight of stairs in a collapsible wheelchair (I still don't know how we got him to fit on there...), of course I had a little trip and hurt myself for a brief time.

Still thinking of you, and looking forward to repeating the experience with your brothers and sisters out there in the world...

- Peace out.

Toilet humour

One funny thing about working major events is the number of calls that lead you - one way or another - into the toilets.

Now, aside from the obvious joke that the toilet is where you'll find disgusting shit - a call into the porcelain shrines usually provides a few chuckles or at the very least a grin or two. That is of course providing you don't actually have to touch anything, and your sense of smell is tolerable of such places. But it seems that the drunk in particular have a unique affection for these places, and I'm never quite sure if it's the constant need to void the bladder after a few too many beers or the fact that somehow - somehow - they know there's nothing we love more than trying to lift a 130kg man from a pool of his own vomit, urine and... other surprises in a confined and crowded space.

Nine times out of ten you're there for a drunk who has either decided the small benches inside some toilet blocks would provide a better resting site than anywhere else outside, but there's always that other one time that keeps you on your toes and reminds you that this can be an unpleasant place to work.

Treating the drunks is usually easy - make sure there isn't some underlying medical problem, help them outside and watch them go on their way (and by that we mean anywhere but here).
Most of the time they just want to be left alone to go sleep off their little adventure, but sometimes they insist of vomiting on you, despite all efforts to convince them that it isn't in their - or your - best interest.

But every once in a while someone comes along to make your life hard. Maybe they've passed out inside a cubicle (a personal favorite, as there's usually no easy way to get into these urine-soaked domaciles without a high chance of getting yourself 'contaminated' - thankfully this has only happened to me once so far), passing out on the floor or (and I've only heard of this happening once) passing out while standing up at the urinals. Fun. I know this is something I'm only going to see more of now in the service, and it's something I'm dreading even before it's really begun.

For all the perks of this job, sometimes you have to put up with a little toilet humour.

Where's the marshmellows?

Driving along one sunny afternoon in the trusty St John vehicle, my partner and I noticed a strange sight before us; a burning vehicle.

Sensing that something was off with this sight, we decided to pull over and check what was going on. Luckily the good folk from MFB were already on scene and doing their thing - but interesting was the fact that we were the only medical team there... The vehicle was very much aflame and there seemed to be some kind of high-temperature fire happening underneath the vehicle, because even after half an hour of absolutely soaking the underside of the vehicle in water and chemicals the vehicle was still merrily burning away.

And did I mention we were the only medical crew there?

We had done the compulsory 'Hi, what's happening?' with MFB, checked out the 'occupants' of the vehicle who were fine and had no smoke inhalation and spent the rest of the time sitting on the side of the road hoping it didn't all go pear shaped.

Fortunately for everyone involved, it didn't, and before long we were able to go again on our merry way. MAS had been held up at a major event for the day and so in the end we, who just happening to be driving past, were all that was available. MFB were very grateful for us stopping I think, and although we all knew fairly quickly we weren't needed, there was always that 'just in case' that made us stick around.

After all, cars and fuel tanks have known to possess a volatile relationship...


All in all a lazy job but with some pretty neat visuals to go along with it - I was happy nobody was hurt, sad that two nice people who had only recently come to Australia had lost their car and wishing that I had brought some marshmellows.

All in a days work ;)

Of Mice and Men

I decided to get into healthcare because I felt like I wanted to make a difference. I wanted to reach out to those in need and make them better, happier or just plain alive.

It was a very short time in my life where I held those convictions, because very quickly I realised how little difference you can make, how a lot of the time reaching out to those in need can earn you a punch, that gentle words and proper treatment doesn't always help the pain, and some people you just can't keep alive, no matter how hard you try.

Despite this, I still found the work rewarding - the small victories keep you going. I loved the hands on nature of the work, chatting with different people and hearing their stories. I loved the random 'How the hell did you manage that?' casualties and the ones that make you think on your feet - sometimes literally, as you wheel a patient across to the acute casualty post.

Some patients stay with you long after you've handed them over, be it by their past, their present and why you're seeing them now or because you know what the future holds for them. A while ago I had a patient that stayed with me for all three reasons.

He was in his early thirties and had been walking home from a night out with friends. He had severe skeletal deformities of congenital origins, the details of which I'll go into in another post. I only mention this here so you'll appreciate further the next sentence. He was beaten - bloodied and bruised - by a mob of bypassers for no reason other than he looked different and was unable to defend himself. They had thrown him down and kicked him repeatedly until he had stopped crying - his arms, legs, chest and even his head.

A civilian happened to drive by approximately ten minutes after the attack and noticed him lying in the bushes, almost invisible in the night and had pulled over to see if he was ok, had noticed me driving by in a marked vehicle and flagged me down.

He was taken to the ED, examined and was found to have 'minor injuries', but was in quite a deal of pain. Combined with his history was going to spend a night or two in ward for observation.

This job stayed with me for quite some time after the attack, the sheer stupidity of it and the damage ignorance had caused. I have no doubts that alcohol was a contributing factor in this attack, and that this is becoming a larger problem each week. Still, this wasn't the first beating I'd had to treat and I wish (oh how I wish) it would be the last - but I know the world doesn't work like that. People are always going to do stupid things for no reason, sometimes damaging the life of another. 'Tough' guys with something to prove beating up an innocent, crippled man.

Despite helping clean him up, treat his injuries, I felt powerless to do anything significant at all. But he thanked me for my help, and despite my feelings of ineffectiveness I felt maybe I had achieved something - even if it was just to reassure him that he was still alive.

Some patients stay with you longer than others, but in some way every patient's story changes you forever. You're never quite the same person after a big job, be it for good or ill, but I like to think of it as I'm always growing. Each day, each job makes me a better person, maybe not from gaining hands on experience but by hearing someone's stories, watching their plight and coming through it. Through their strength I gain my own strength, through their struggles I can overcome my own.

For that I am always thankful, and ever wanting to be better at what I do.

Vomit transfer protocols

I’ve mentioned quite a few cases of dealing with drunks in my short time blogging, but I’m always amazed at the people who feel it’s perfectly normal to put themselves into a state of severe inebriation. Now I’m no saint – I’ve sported more than a few hangovers in my time and, on occasion, put myself into a state of severe inebriation – once following what I’m sure was a reaction to the high preservative levels in extremely cheap wine (I’m allergic to sulphur, of all things…). Thanks go out to Clare for looking after me! (Still sorry…)

I can say however that those events were fairly few and I know for a fact that my days of drinking more than a glass or two are well and truly over. But I’ve noticed some of my friends show a little disappointment in this decision – it’s very Australian to go out to the pub and crawl home.

Working with St John (and also a few bursts of looking after friends at parties) I’ve been abused verbally, had punches thrown at me, had a bag of vomit thrown at me, pulled people out of gardens, been vomited on directly and passively (explanation to follow!). You reach a point where looking after the drunkards makes you realize just how unappealing drinking is – and not just for yourself.

The times I was vomited on directly usually run something like this; security bring someone over who is obviously drunk. They deny being drunk, despite their breath smelling like the bathrooms of Young and Jackson’s Pub following St Patrick’s day and a stupor that would impress a Zen master. After taking their obs they suddenly announce they don’t feel so good, you turn to get an em-bag only to find they project over the bag and onto your uniform. I’m proud to say I have since become the ninja of vomit dodging. Unfortunately, practice made perfect.

The passive vomit stories are the worst though. We get called to a drunk who is passed out in a pool of their own vomit. They are covered in it. A sterna rub or shoulder pinch brings them to (usually angry) but we convince them to sit up. Now we have to walk them over to a post, and the fun begins. We can clean up the vomit off their face and hair, but clothes soak in the stuff – and as we’re sometimes forced to do the old ‘throw your arm around my shoulder’, we get to join in the soaking. Occasionally we’re lucky enough to have waterproof (and hose-clean-capable!) jackets or a scoop and stretcher – but often resources are spread just thin enough to make the shoulder the only quick method of transport. That is passive vomit transfer, and the stink stays for the rest of the duty.

Getting sick and vomiting is only a small part of the problem however – but I’ll save that for next post.

Stay safe.

Took their breath away (but gave it back again)

There are a few perks to being a member of St John that often get either overlooked or blown completely out of proportion - the one I had recently was that of the adoration of dozens of schoolgirls. I had to laugh.

The basic story - at a high school sports carnival we had two kids run into the first aid post yelling that their friend couldn't breathe. This usually translates to asthma attack, so we grabbed our gear and off we went. The girls ran ahead, but we (professionally) maintained our steady walk. We got to our patient, a young girl with (*surprise!*) asthma. She was breathing shallow with a bit of a wheeze, but was conscious, alert and stable. We administered Salbutamol - she had her own but had left it upstairs in her bag - as well as a nice steady flow of oxygen to give her that universal pick-me-up. When she was a little more recovered we walked her over to a room we had set up and put her into a stretcher for a little bit to rest it off.

I could have told her that morning that participating in two endurance events without her Salbutamol handy might not be the best idea and a minor asthma episode was to be expected. What I hadn't expected was to emerge from the room to have dozens of girls staring at me. It was very... Children of the corn.

One of them piped up with a worried look on her face "Is she going to die?" - I let out a grin.
"It's ok, she's fine - just a little asthma. She just needs to rest for a few minutes and she'll be out again."
"Thank you!" the girl cheered and ran off.

The rest of the duty went quietly and quickly - another minor asthma episode and I was free to go home from yet another job well done.

When vehicles attack!

It's common knowledge that some Paramedics attract certain kinds of jobs - even before I've become a fully qualified Paramedic I know my niche.

I attract car accidents.

Since joining St John Ambulance, I have had at least 8 car accidents happen right in front of me. Normally I'm in civilian clothes, but have my trusty kit in the back of the car (something I highly recommend people get!) and have been able to help out where possible.

Usually they've been low speed collisions, for a long time the most major injury I had to treat was a bleeding scalp following a minor spidering of the windshield. Of course, I made a point of saying 'until recently' because this leads into todays story...

A car was t-boned (one car ramming head first into the side of another) in front of me, the scene instantly turning to chaos. I pulled my car onto the grass and jumped out, kit following me. Fortunately I was in my StJ overalls, so people actually listened when I yelled for an ambulance. The driver who hit head on was fine, walking from the wreckage left behind him with only a look of disbelief and slight tremble of the hands. The driver who was hit side-on was a different story, having not had the luxury of a full crumple zone to lessen the impact.

He said he had lower back pain and pins and needles down his legs, so I told him to stay sitting and try not to move while I did a quick primary survey to check for bleeding. Luckily I didn't find any (although this does not rule out internal bleeds), and quickly jumped into the passenger seat behind him to immobilise the c-spine (his neck) with my hands. Unfortunately I had switched from a marked St John vehicle only a few hours prior, and would have had the luxury of proper fitted collars - but I knew this would do until the ambulance arrived.

To everyone's luck the ambulance arrived in short time and we got a collar on and we got the driver onto a spine board to be loaded. The crew thanked me for my help and everyone went on their way.

This job left a firm thought in my mind that I was doing the right thing by applying for the ambulance service - and also gave me the confidence to believe that I could actually do this. I hated the feeling of not having the equipment I knew I needed, but at the same time enjoyed (not the right word, but you get the idea) the fact I had to think on my feet.

I also learned a quick lesson in patient management, having my friend in the front shifting from time to time (with me grumbling at him to stop each time) until eventually I just warned him he could move one more time, shift something and never be able to move his legs again. It's strange how these words can make a grown man sit as still as a well trained schoolboy.

I wander how he ended up - it's hard not knowing. Hopefully it was nothing but a bit of pressure from a swollen disk, or a pinched nerve that healed itself. There's always the chance that was the last day he ever walked, and I have to be open to that possibility no matter how much I dislike it - being honest with yourself is the only way to survive the job for a long period of time. I doubt I'll ever find out, but I like to hope maybe I made a difference by being there.

Can't we all just get along?

This post is something I struggled with for a long time in terms of how to go about writing it. It involves two organisations, both of whom are involved in emergency health care, one on a professional level and the other on a voluntary level. Let's call these organisations St Peter Ambulance and City Ambulance Services to ensure that you realise I'm talking on a hypothetical scenario ;)

Now I'm well aware that there are members of St Peter Ambulance (StP) who probably shouldn't be allowed within a 100m radius of a patient. Still, they somehow slip through the cracks of screening (a problem associated with volunteer organisations) and end up on the wrong end of a pair of nitrile gloves. The wearing end, that is. Still, overall I would say that the members of StP are competent and professional in their conduct, are highly trained and motivated people giving up their time for a good cause.

I could understand, however, why some members of City Ambulance Services (CAS for short) might have some problems with some of StP's members and their conduct in potentially dangerous scenarios (such as extrication with severe trauma, certain drug episodes and other events requiring extensive medical knowledge). Sometimes this gets taken to an extreme, and unfortunately everyone suffers.

At a major music event somewhere in Australia some time ago, the members of StP's were informed by CAS that they were under any circumstance allowed to move a patient, and that this must be done by CAS. In addition, the StP's 'acute trauma unit' staffed by Doctors and Nurses wasn't to be used if the patient couldn't walk to it unassisted - they would be taken directly to hospital again by CAS. The event had multiple performance sites with crowds in the thousands, StP's in the dozens and CAS's by the handful. Unfortunately, CAS were under equipped and were forced to borrow StP's gear and had insufficient 'buggies' to move patients from site to site.

Two conflicts were (hypothetically) created from this scenario - the StP's were, for the most part, unable to perform their duties fully with the restrictions in place, and the CAS members were run off their feet trying to move people from site to site or to hospital for things that the StP's and the StP trauma unit could have treated.

I won't comment on the origins of this hypothetical situation, but I will say this: the day was made significantly harder than it needed to be because two organisations couldn't play nicely. Blame lies on both hypothetical ends and, unfortunately, it's the patients who suffer because of it.

Situations like this - and it's not the first one I've hypothesized - are one of the many things that are wrong when various health care organisations don't play nicely.

I know we might not always like each other, but come on people - can't we all just get along?

I also look after fools and drunks

I was with St John (as I'm known to be) at a local event where the crowd was happily served copious amounts of alcohol. While I usually dislike these events for the obvious work it provides me with, the crowd were actually a pretty good group of people all out for a nice fun time.

Of course, for two of them, the day after may have been slightly less so. Actually, for more than two - but let's just say these two in particular ;)

The first was a girl who had consumed her fair share of beer and then a little more. After that she drank herself silly. Thinking this might be a good time to head outside and purge her sins, she told her boyfriend her intent and strode forth into the night. After some time the boyfriend (who had stayed inside the warm room filled with friends) got a little worried, and before long we were called to an unconscious female in the garden.

On a side note folks, why always the garden? It's full of prickles, thorns and bugs - please, please try to pass out somewhere a little more convenient for me to get you from!

While she wasn't at the point of needing her stomach pumped, she certainly needed to sleep this off. Her boyfriend and a few friends were with us, which made my life a lot cleaner - I got them to hold the em-bag while she continued her projectile ways. The unfortunate thing for me was the fact that her location was completely inaccessible by vehicles (such as the one a friend was driving around to take her home), she was a large girl and was in no state for walking.

Out comes my best friend, the scoop stretcher. If there is one piece of equipment I recommend all first aiders get - it's this. We load her into it, secure her and (with the help of myself, a partner, the boyfriend and three other friends) take her over to the car. There was a bit of a wait, so we released her from the scoop and we sat around talking for a bit. Although drunk, she was a lovely girl and liked my sense of humor - this was also a good thing because I love an audience. A captive audience best of all.

After a few stories, jokes and musings she said something to me that I doubt I'll ever forget - "You're good at this." For some reason that simple statement made by a drunken girl sitting on cold concrete with a half full em-bag in her lap remains one of my warmest, fuzziest memories of first aid. I felt like, in my own small way, I had achieved something that night. After a bit the friend appeared and we got her into the car for her adventure to continue while we headed back to our designated spot.

A year later at the same venue and event (it runs every year) I met our second drunk. We were called to her under similar circumstances as our last friend, out in the garden 'unconscious' (of all the calls for 'unconscious' I've had, only around 5% of them actually are unconscious...).

Seriously - stop going to the garden, people.

Unfortunately this was the one time of the night when all the people requiring first aid needed us at the same time, so I was caught between treating her and also inspecting a young man who'd recently been in a fight. Luckily they were scant meters from each other, so my life was made somewhat easier. The girl was GCS 3,5,6 - but the 5 was borderline 4 depending on which time you roused her. Drunk girl this post, fighter in a later dedicated post (oh yes, it was a good one).

We got her into a stretcher (I had learned from last year), covered her in a nice thermal (foil) blanket/wool blanket combo and were wheeling her over to the car park so she could get a taxi to her friends place. She probably could have walked, but she was a very petite girl, continuous going 'floppy' and thus was extremely difficult not to drop - I was erring on the side of caution. I was also using this as a way of getting away from the 'fight scene', but again more on that later.

The girl was great when she was talking, a very giggly drunk and rather entertaining actually. While I couldn't stand it all night, a 5 minute stroll was quite enjoyable. The big laugh came when we approached the taxi area with the girl in a stretcher and, unsurprisingly the taxi just took off. We sat her up with her friends to wait for the next taxi with her thermal blanket still around her ("You look like you're about to be thrown in the oven!") and left them to the night. I was proud of the partner I was with, as it was her very first duty and she had handled herself well (which I of course told her), and she said she was impressed with all of our friendliness and humor and was keen to do more duties.

I heard through a friend of a friend that the girl made it back safely to wake the next morning still wearing the thermal blanket - but didn't remember how she got it. It's always nice to hear how our patients have recovered - better still when it can give you a chuckle.

Don't tell lies

There is of course another side of the coin when it comes to my last post. I like to think that omitting information (or flat out refusing to give it) is more of a deficit of honesty more so than lying, so I bundled some of those examples into that post. Some people, however, just flat out lie. Not through omission, not to save their skin - they just lie.

Several cases in point; at a recent festival a member of the public came to my post and reported an unconscious male locked in a bathroom cubicle. On goes the response gear - a giant pack filled with Oxygen, breathing apparatus and other gear on me with a response kit complete with trauma gear and defib for my partner. Not the easiest gear to carry but we do it without complaint or question - it's the gear we need to do our job. We make our way around the corner to the bathrooms and I check every damn cubicle - all of them in use and filled with an angry male wanting to know why I was banging on the doors. Nobody else had seen our supposed unconscious male, and some patrons had been waiting for a cubicle for quite some time.

Now, I'm not afraid to go on a wild goose chase ('That's what wild geese are for.' - Anon), because I'm fearful of that one time we don't go when we are needed. But why would someone make up a story like that? It got the reporter about three seconds attention from us but wasted about fifteen minutes of our time. Time that we had to mark ourselves as a response crew as 'responding and unavailable'. At this event we had a rather large amount of drug OD's - and they wasted our time on this? But sometimes it's not the reporting of a patient that's the lie... Sometimes we have something much more fun in store.

And these are the cases that really irritate me - people who have nothing wrong with them, but they insist on treatment. These are the teenage girls who've 'fainted' at concerts, the patrons who travel around first aid posts at large events getting paracetamol from each post (we usually catch them out, but unfortunately they can get as much as 3mg before the flags get raised), the hypochondriacs who insist on us calling an ambulance for their 'broken leg' despite walking in with no problems only to find out this post doesn't stock penthrane.

It's the active lie that can do much more damage to our patients, ourselves and our work. I can understand sometimes why people might lie - the elderly or homeless sometimes just want someone to talk to, youths often just want attention and sympathy, addicts might want to score a pain killer when they have no money - and this is one of the things that worries me most about emergency medicine. You see, the problem with medicine outside the hospital (and even in many cases inside) is that we have little in the way of diagnostic equipment. For this reason EMS is rarely allowed to diagnose patients - but it's still a big part of what we do. So how do we go about doing this without said equipment? We have to depend on the patients complaints and symptoms to guide us.

For this reason the homeless will get their night in A&E in the warm bed, youths will get their attention and yes, addicts do score free pain killers - because we have to trust them and their word, because some times there is little else we can do.

Rule 1 of Emergency Medicine is everybody lies.
Rule 2 is supposed to be 'Never forget Rule 1'.

I sometimes think a much more appropriate rule 2 would be 'Know when to forget rule 1'.

Just be honest

Something that always amazes, amuses and mortifies me is the truth behind rule number 1 of Emergency Medicine.

Everybody lies.

One would be forgiven for thinking that, while being in an emergency situation, a medical technician might be provided with all of the important, relevant details needed to adequately treat their patient. This is not the case. Several instances stand out in my mind when 'the gang' is gathered and sharing battle stories in regards to this.

I was at a major festival at one of the busiest posts when, not surprisingly, an underage female is brought in with suspected OD. While she was stable, it was vital for us to be told exactly what she had taken or done in order for us to treat her in such a way as to improve her condition or ensure the proper care was given... Her three "BFF's" were gathered around crying she was going to die and the usual rants we hear in these situations (they'd be amusing if they weren't so annoying), and yet not a single one of them would tell us what she had taken. Oh, they knew, but (and I quote) "[they] don't want her parents to find out!". She was in no trouble at all, the only way her parents would find out is if a) she told them or b) we were forced to send her to hospital in which case the hospital would be forced to notify the parents given she was underage.
I always like to think that if it come between getting in trouble but being alive or not getting yelled at but possibly dying, I'd choose the former. Just me, perhaps.

Another case that comes to mind was at another festival where many people were brought in with scratches, lacerations or other injuries consistent with being scraped by a wire. It was funny, but I recalled hearing on the event radios of people jumping fences... But these people told me they cut themselves on cans after falling over... Also funny, this event doesn't serve drinks in cans... What's that? This was outside the event, before you came in? Of course it was. We didn't care how they cut themselves (although our paperwork requires us to ask just for record keeping), but knowing what people cut themselves on can be the difference between knowing a simple clean and cover will suffice or if they might need a shot after scraping on that rusty fence. Of course I recommended the shot given the 'nature' of the injuries to be on the safe side...

Of course my favorite to date (although perhaps not as medically relevant) comes from the humble drunk. How did you end up in the gutter? "I was just having a drink, minding my own business and the guards kicked me out." Do you remember how you got that black eye? "What black eye?" The police want to have a quick word with you regarding the patient in the other post, the unconscious one. I'll be back in a minute. "Never seen him in my life." I'm sure his fist looks familiar. Bloody-toothed grin ensues.

The short of it; we're only trying to do our job, and the more details we have the better we can look after you. We don't disclose details to anyone without your permission (yes, even including the police) so please, just be honest.

The problem with makeup...

Some of the concerts I go to with St John provide enough amusement just from the audience - the show itself is just an added bonus. One such night stands out in my mind, however as I'm sure you'll come to understand it was only a while after that I was able to appreciate the situation as humorous.

Without mentioning names, a shock rocker was in town and performing - surely enough St John Ambulance was there to keep an eye on things should said things turn nasty. The crowds were massive, especially for such a fairly small venue, and we were expecting to have a busy night ahead. As usual, we had an 18-30 year old crowd but given the nature of this event most of them were goth - which we all had a giggle at as we walked in.

Oh, how the tables turned on us.

The night quickly became one of the busiest I'd worked for some time and we were frequently swarmed with more patients than Johnno's. Luckily the injuries were usually very minor and more often than not a sit down and a quick drink of water was all they needed, but the time it took to properly triage was extensive.

Why? Well, there was of course the difficulty in assessing their complaints given we were located next to the speakers. Next comes the fact that most of them didn't really want to talk to us. But finally, and most infuriatingly of all, it was impossible to tell at a glance who was genuinely sick or having trouble breathing because everyone was wearing white make up. Everyone came in looking like that were about to 'cease to be'.

It was a good if not frustrating night after all, the crowds almost rioted and we were contemplating a tactical retreat when the main act failed to appear 45 minutes after his set was supposed to start. This created just the right mix of tension and hostility in an already angst filled crowd to keep a steady stream of injured out way...

And here I always thought they 'didn't feel anything...' ;)

Attitude

Sometimes the work I do with St John makes me wonder what I'm getting myself into. Don't get me wrong, when I'm on duty with St John and treating people I feel like I'm doing what I'm supposed to be doing with my life - it's just there are downsides as well as those upsides.

Take this article for example, coming from a very well respected Paramedic from the same city in which I live. I've had the privilege of working with Mr. Eade during my time with St John and have found him a knowledgeable, kind and hard working man - the story does not give him enough praise for his work, but nor would he want it to. But the content of the article raises many issues with the way Paramedicine works in the field - often Paramedics are forced to work in dangerous situations and in increasingly violent environments.

It's not surprising that many Paramedics worldwide want to wear stab vests to protect themselves when on call. Of course a few years back there was the story about an EMS worker wounded by a sniper ambush. There have also been random stabbings, beatings and then there was this story which I don't know where to begin trying to talk about...

I've talked about this with my girlfriend and family and they know some of the risks that are involved in working as a Paramedic - I'm grateful that they all still support my choice. Some might say they are trying to get rid of me, but I like to think they just want me to be happy ;)

Working with St John I've noticed a lot of small things already that make me wonder about some people, I'll run through a few examples so you know what I'm talking about. All the time we get people throwing up behind our vehicles when working at Festival Hall. At the Myer Music Bowl we get people urinating behind (and on) our vehicles. We also get abused when pushing through crowds to get to patients, we get abused by 'friends' of the patient who insist that despite their friends unconscious state 'they don't need [our] help'. Some patients swing at us when we're trying to treat/help them. A while back we were abused for knocking a guys sunglasses off when trying to get to an OD patient, he followed us for a while shouting abuse.

And I couldn't think of any other job I'd rather be in right now.

Now I know (especially when compared to the earlier examples) that what I've experienced so far are only minor irritations compared to what Paramedics encounter every day, but it's the bits that surround those brief moments that make them bearable. It's about getting a non breathing OD patient breathing again that makes a guy following you talking about sunglasses laughable. It's knowing that I enjoy what I do, and that I'm doing something valuable for the community that makes cleaning [censored] covered vehicles easy.

I know I won't always be working in the safest environments (although I will do whatever I can to make them safer for me, and if they're too bad then I won't endanger myself needlessly) and nor will I always receive the respect that I think a Paramedic deserves. In fact, rarely do I think will I receive the respect a health care professional deserves, but at the end of the day I sleep feeling I've done something right - even if things didn't go the way I'd like them to - that makes me love first aid, and wish to continue that into Paramedicine.

And that's the attitude I hope to keep.



Side note; Thursday the 10th of January is my Paramedics Interview and Driving Test (I'm doing two rounds in one day to 'speed up' the enrollment process - their words, not mine *grin*). I'll be sure to let everyone know how it goes!

Life Choices

Some patients make you sit and think about the way we live our lives. These can range from the elderly with stories of their life to the drunk 13 year old girl crying because she's afraid her parents are going to find out she's been drinking.

Others just make you wonder how they made it this far.

At an all day music festival with St John I had a 22 year old male come in to our post with blood all over his face. Oh, how I wish this was a rare occurrence at such events... Long story short, he'd split his lip, eyebrow (although it didn't need stitches) and had a rather nasty swollen eye. While getting a history he'd denied taking any drugs that day (as almost everyone else has said) but I always had a feeling he was lying. Call it a sixth sense, or the fact he was agitated, his pupils were dilated (although still PEARL) and he was having trouble obeying orders to hold a cloth to his nose to stop it bleeding. Of course it was possible he was just a nervous, oddly behaving type of guy so I had nothing I could really hold him on (add to the fact he was built like a tank, myself being built more like a mini I didn't like my odds of holding him anywhere) and he was anxious to get out of the post.

The day moves on as one would expect, and after two or three hours a familiar face is found once again at my post. He'd managed to get himself into another fight - of course not his fault - and his face was once again a bloody mess. That sixth sense was still tingling, his paranoia had increased as had his pulse and respirations. Mood was swinging a little more, but after I cleaned him up again some friends said they'd take care of him.

A few more hours pass and I was dropping off a patient into the Advanced Casualty Management Team (ACMT - a 'mini emergency room' if you will we set up for big events) when who should I spot but our dear friend Mr Bloody Face being treated by one of the nurses. I let someone in there know he was a frequent flyer and it might be an idea to have him 'move on' to the outside world.

More hours pass and I'm beginning to see the light at the end of the tunnel. I'm almost ready to go home, when I get a call to respond to an unconscious male at the security office. As I get closer and closer I see a familiar face sitting in the security office. By this stage I could recognise him bloodied and bruised, after a minute with him I could see he was up to his old tricks. He'd been jumped by four guys after he'd picked a fight, although he had never lost consciousness. He was crying and kept repeating he wanted to go home, and although I got a base set of obs and was confident he wasn't in any life threatening situations, it was clear by now that my suspicions he'd taken Ice were more than likely correct, despite what everyone was saying.

It had been a long day, he was probably dehydrated as well as bloodied and bruised, agitated, anxious, paranoid and more than likely scared out of his mind being surrounded by security guards (although they weren't crowding him, the fact he was at the security office made their presence abundant) and two people with 'Ambulance' on their rather police-like uniforms - add to this Ice is known to give massive mood swings and increased hostility/aggression. I knew these things. Still, the sudden snap caught me off guard when he threw me away from him and starting swinging at everything and anything around him.

Luckily he didn't make contact with me (apart from the rather firm shove) and guards were quick to jump on him and pin him to the floor. His friends tried to calm him as he screamed and attempted to fight off his restrainers (luckily with no success). We had called in an Ambulance and Police by this stage, and as the Ambulance arrived he had calmed down sufficiently to let the Paramedics treat him under security supervision. Knowing the night was not yet over, I headed back to my post to wait for the next call until I could return to that glorious, soft bed and call it a night, knowing the Paramedics and Police would sort out our friends fate.


I've stated previously that I don't like to judge drug users, or anyone I treat for that matter. Their life is their life, and I'm only there to help when they need it. Sometimes I just feel sorry for people like the patient I've just talked about - if they could do it all over again, would they make the same decisions? If he had have known at the start of the day what would occur, would he still have done the same things? In the end we're all responsible for our own life, and hindsight is a wonderful thing. It might be that he was an otherwise great bloke, who I would have been more than happy to share a beer with down at the pub - I just caught him at a weak and vulnerable moment. Of course he could be a complete arsehole.

I just hope when he's back in his mind he has a good look at his life choices.

That's not where I left it...

So today's post will be themed around things not being where they're supposed to be. Namely, body parts.

Recently I came across such a case and it occurred to me that I was not the person I once was. I discovered this when two people walking past the scene stopped and stared at disbelief before swearing with such voracity that even truckers would blush. It hit me then that witnessing dislocations, breaks and bleeding had no effect on me anymore - they were now clinical problems that had to be treated and solved.

The first such incident was a lateral dislocation of the patella (or knee cap to us) - luckily for the patient it had clicked back into place on its own, unfortunately it looked like he had a bit of damage to the tendons. That'll be a fair bit of physiotherapy.

Next came a double break - that's right, the radius and ulna bones of the left upper limb had been snapped clean in two leaving the arm to fling around like a rat on a stick. Manipulation, perhaps surgery and of course physiotherapy.

A dislocated and fractured ankle from a happy fence jumper comes next, the bones pulling on the skin until it was white... Luckily the foot still had blood supply, so just manipulation, surgery and physiotherapy.

Another ?fractured ankle, but a bit of an odd one. There was no swelling, but there was also no sensation at all. Couldn't bear weight or push/pull against my hand. I'm guessing x-rays, maybe ct scans, a few scratches on the head and something from there. And physiotherapy.

A MVC leaves a woman with a whopping bump on the noggin (and a pretty spider web on the windscreen). A fall onto hard ground leaves a shoulder dislocated but leaves the arm with blood supply (physio).

I sometimes wander if it's a good thing I'm becoming more and more detached from this - will I reach a point where nothing phases me? I'm not so sure if that would be a good thing, but at the same time I wouldn't want every case to stay with me. In some professions more than others, you shouldn't take work home with you. How will I work out? Time will tell, but currently I'm happy with my reactions. I still have the internal monologue of "that's so cool!" followed by "Can I get you some pain relief?", but I don't know how that would apply to some of the more serious accidents.

Moral of the story? Make sure you leave things where they belong - otherwise a man in a little blue jumpsuit might be grinning at how cool it looks. And you'd need physiotherapy.

Common sense (and why it isn't always common)

A good deal of what we do in first aid is common sense. Anybody can do it - most children, when asked what to do if they cut themselves would be able to tell you to put a band aid on it. There is one little catch, however, that has shown me time and time again why such a simple thing to treat can be changed into something a lot more complicated.

From the newest member to the most hardened veteran of first aid (sounds silly, I know), I've seen people freeze up at certain types of injuries. Some people don't like blood (again sounds silly but I've seen first aiders go pale at the sight of it), while others don't like screaming patients. I've done it too, but I'm trying more and more to stop it. Sometimes your brain needs a few moments to collect itself when confronted with a particular sight, and it's something that you need to condition yourself out of in order to become better at this. Some injuries require immediate attention, so you won't be given those moments, and it's a trend I'm noticing going through the Paramedic literature that an important part of the job is getting around that initial mental hurdle to get back to that common sense.

But this raises another point - Paramedics condition themselves to adrenalin, as the job puts the body into a stressful state for frequent, long periods of time. This is a two edged sword; it allows the Paramedic to work in stressful situations to accomplish that which may not ordinarily be accomplished, but it can also lead to chronic fatigue and a depletion of mental resources. It can burn you out. A good Paramedic will be able to find that balance, the sweet spot between exhaustion and exhilaration that leaves them in the right frame of mind for the job. I've heard it's not easy, and not everyone can do it despite their best efforts. It can hit you straight away, or slowly wear you down after years on the job.

Will I be able to find this spot? I hope so, but I guess you'll only ever find out through a trial of fire. All else fails, I like to think I'll still be able to use my common sense.

Dance the night away

It was a duty like any other, only it happened to be a youth dance competition... At first I thought it may have been the annual Oompa-Loompa reunion given the amount of orange skin and wigs.

After several hours of boredom a young boy (around 14) 'hopped in' complaining of an ankle injury after a stumble when leaving the stage. I had a quick look by lifting up his pant leg and then fled to the opposite side of the room calling on anything holy to protect me (of course, this didn't really happen...) as I noticed his ankle was around three times the size it should have been. After taking a few more obs I followed the nifty little RICE mnemonic for soft tissue injuries and was recommending the joys of a trip to the local hospital to get an X-ray to be on the safe side. This was not to be...

The mother of the boy refused to leave, saying the child still had one more round - the Grand Final to compete in. I looked at his ankle. It looked back at me, whimpering. I looked at the boy, who seemed determined to keep his mother happy despite the risk of further (major) damage to his already damaged ankle. As the boy was under 18, his guardian had right to deny treatment.

I hadn't removed his shoe, given it was holding in the swelling somewhat and the parent had already said they wanted him to be able to dance. If the shoe came off, the swelling would immediately spread down into the foot and any hope of getting a shoe on again (and thus his ability to compete) would be lost. I was so tempted to take that poor boys shoe off... But alas, I had not the right.

This places us in a tricky situation. I had fully informed the mother of the potential harm she was doing her son, but still she refused. After a bit more talking we came to an agreement (which I still hated) - she took her son from the First Aid room back to the event, covering his ankle with his pants (thankfully loose fitting). Nobody was allowed to know he had been there (not that we give out any details on our patients) and, if we pretended nothing was amiss she would 'allow' us stand side of stage if he collapses. How caring of her.

This is where the story gets strange (I know). The boy goes on to dance. The boy wins the championship. Nobody notices his ankle, three times the normal size, and he walks off stage as if nothing were wrong. That boy must have been in tremendous pain - and as he walked to his mother out of sight of the crowd you could see his limp and unshed tears.

He may have won this championship, but I shudder to think the damage he may have done to himself or - more to the point - the damage his mother had 'allowed' him to be exposed to. I hope he's still out there dancing (he was good), but I'm hoping more that he was allowed to heal before his next competition.

Some people just shouldn't be 'allowed' to have kids.

Keep the tip

Over the weekend a bunch of high school friends and I got together again for the first time in a long time. It was great to see everyone, but I had to travel quite a distance back out there as I've done a bit of moving since graduating. Unfortunately, only half of the people we were expecting turned up, and from them only half the people could really stick around for the full time - however one of the people leaving was leaving for work a few restaurants down from where we were.

So we tagged along :D

It was a great night of catching up, with plans to get the full gang together again soon (damn pikers ;P). At the second restaurant for the night we grabbed some dessert and were entertainingly served by our friend (who, after a few jokes from the gang I'm scared we almost got fired - sorry!).

So where does this blog come into all of this? As we went to pay for the dessert, my friend tells me (rather sheepishly) that one of the kitchen staff had an 'accident' in the kitchen. With a knife. And their fingertip. Well, an ex-fingertip.

Kitchen staff are notorious for these kinds of injuries, so I thought they'd probably know what to do, but offered to have a look at it anyway - which was kindly accepted. On my way in I PPE'd up from my belt pouch much to the amusement of my friends. The injury was fairly minor, she had taken the tip of her finger off but had left little skin remaining - they had found the tip from the floor but the likelihood of re-attachment was low given the size. The main concern was the bleeding, as she kept removing the paper towel they had over the finger to 'show everyone'. This has the lovely effect of removing any clots that may have formed to stop the bleeding, the end result making the wound appear much worse than it is and increasing the time taken for a proper clot to form.

After asking for one more show so I could assess, I got a knuckle bandaid and used the non-adhesive dressing over the tip and told her to keep pressure on it, put some wrapped up ice around the finger to reduce blood flow, told her to keep the hand elevated and do not use the hand - at all. She would have to go to A&E; best case to do a proper clean and cover, worst case to get a skin graft to cover the tip to let it heal properly. She had taken a fair chunk off the tip... After a bit of chit chat they worked out it was best to get a private car to the hospital and so I left them be to return to my friends.

One thing my friends and kitchen staff commented on was the gloves. They asked if I always carried them (to which the answer was yes) and why (to which the answer is you never know when you'll need them). A pair of gloves are a wondrous thing to have on your person at all times - they make great ice bags, let you pick up undesirables and other assorted fun items and, occasionally, can be used for first aid. For this reason and others I always carry my belt pouch regardless of where I'm going and I'm finding time and time again how valuable the little bugger is. $15 is a small investment for piece of mind.

I'll have to remember to check how the finger went and what A&E did, depending if they mind or not I'll throw the update in here. I think the hardest part of this job was resisting the urge to make the plethora of rather poor jokes that were running through my head at the time - although I am afraid to say one or two snuck out.

Read the post title one more time - and let that sigh/giggle out ;)